III期胸腺瘤上皮性肿瘤诱导治疗后手术切除：108例多中心分析的长期结果

Induction therapy followed by surgical resection in Stage-III thimic epithelial tumors: Long-term results from a multicentre analysis of 108 cases.

作者信息

Cardillo Giuseppe, Lucchi Marco, Marulli Giuseppe, Infante Maurizio, Leuzzi Giovanni, Mussi Alfredo, Carleo Francesco, Facciolo Francesco, Voulaz Emanuele, Rea Federico, Rapicetta Cristian, Lococo Filippo

机构信息

Unit of Thoracic Surgery, San Camillo-Forlanini Hospital, Rome, Italy.

Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery, University of Pisa, Pisa, Italy.

出版信息

Lung Cancer. 2016 Mar;93:88-94. doi: 10.1016/j.lungcan.2016.01.008. Epub 2016 Jan 19.

DOI:10.1016/j.lungcan.2016.01.008

PMID:26898620

Abstract

INTRODUCTION

So far no specific oncological strategies have been validated for locally-advanced epithelial thymic tumors (TETs). We herein report the long-term results of a large multicentric experience adopting a multimodal treatment.

METHODS

From 01/1990 to 12/2010, the clinical data of 108 Masaoka Stage-III TETs patients surgically treated after induction therapy (IT) were retrospectively reviewed. Different IT-regimens were administered: ADOC (32 pts); PAC (38 pts); CEE (38 pts). Radiotherapy was concurrently used in 5 patients only. The end-points of the study were the evaluation of: (1) resectability; (2) overall long-term survival (LTS) and disease-free survival (DFS); and (3) independent prognostic factors. The Mann-Whitney and Fisher's exact tests were applied to test the associations. Survival analysis was performed by the Kaplan-Meier method and log-rank test.

RESULTS

Mean age and male/female ratio were 51 ± 13 years and 61/47, respectively. World Health Organization (WHO) histotype was: A in 6 pts (5.6%), AB in 18 (16.7%), B1 in 15 (13.9%), B2 in 26 (24.1%), B3 in 23 (21.3%), and thymic carcinoma in 20 (18.5%). Thirty-day mortality was 1.8%. A total of 81 (75%) had R0-resection, 11 (10.2%) R1 and 16 (14.8%) R2-resection. Adjuvant therapy was performed in 71 patients. During the follow-up a relapse of disease was observed in 38 pts(35.2%). Five-years DFS and LTS were 69.3% and 79.3%, respectively. At univariate analysis, WHO-type B3/C ("high-risk") TETs (p=0.001) and recurrence of disease (p=0.02) were predictors of poor LTS while only a slight correlation was found for R-status and "CHT-regimen type" (p=0.097 and p=0.067, respectively). At multivariate analysis WHO "high-risk" TETs (H.R.5.73;C.I.:1.77-18.57) and ADOC-regimen (H.R.2.84;C.I.:1.37-5.86) were independent predictors of poor survival.

CONCLUSIONS

A multimodal treatment for Stage-III thymic tumors may achieve a rewarding survival. WHO-Histology seems to be the most important prognostic factor.

摘要

引言

迄今为止，尚未有针对局部晚期上皮性胸腺肿瘤（TETs）的特定肿瘤学策略得到验证。我们在此报告一项采用多模式治疗的大型多中心研究的长期结果。

方法

回顾性分析1990年1月至2010年12月期间108例接受诱导治疗（IT）后接受手术治疗的Masaoka III期TETs患者的临床资料。采用了不同的IT方案：ADOC（32例）；PAC（38例）；CEE（38例）。仅5例患者同时接受了放疗。研究的终点包括：（1）可切除性；（2）总体长期生存（LTS）和无病生存（DFS）；（3）独立预后因素。应用Mann-Whitney检验和Fisher精确检验来检验相关性。采用Kaplan-Meier方法和对数秩检验进行生存分析。

结果

平均年龄和男女比例分别为51±13岁和61/47。世界卫生组织（WHO）组织学类型为：A期6例（5.6%），AB期18例（16.7%），B1期15例（13.9%），B2期26例（24.1%），B3期23例（21.3%），胸腺癌20例（18.5%）。30天死亡率为1.8%。共有81例（75%）实现R0切除，11例（10.2%）R1切除，16例（14.8%）R2切除。71例患者接受了辅助治疗。随访期间，38例（35.2%）患者出现疾病复发。5年DFS和LTS分别为69.3%和79.3%。单因素分析显示，WHO B3/C型（“高危”）TETs（p=0.001）和疾病复发（p=0.02）是LTS不良的预测因素，而R状态和“CHT方案类型”仅存在轻微相关性（分别为p=0.097和p=0.067）。多因素分析显示，WHO“高危”TETs（风险比5.73；置信区间：1.77 - 18.57）和ADOC方案（风险比2.84；置信区间：1.37 - 5.86）是生存不良的独立预测因素。